Not every persistent AF case stops at PVI ⚡

Added: 2026-05-16

[00:00:00]So this patient as Dr. Waheed mentioned, never had an ablation before.

[00:00:04]But we kind of had the feeling older women woman small person, she might have have some substrate and I just going to share with you how our workflow in this patient is. So as I said, this is not my workflow normally. Normally we would go mapping on the fly. So do the veins and just map while we're doing it. In this case, we did a little bit of mapping before. As you can see, we could detect some substrate on the anterior wall and also on the posterior wall. And you guys can already already think about what should be tackled after doing the PVIs because in this patient we might even tackle substrate outside the pulmonary veins.

[00:00:40]So but having said that, I'm going to start with the left superior pulmonary vein. Now you can see the wire is already in the left superior vein. Now what you want to achieve with the balloon here, accordingly to cryo procedures, you want to have good contact. And in this ball technology, you kind of have a circle that indicates you if your electrodes are in good contact, poor contact or no contact at all. You see those blue bars, which means like ideal contact. Then you have some bars moving out of the second inner ring.

[00:01:10]That also indicates you that these electrodes are in contact. And depending on respiration, sometimes our patient is in deep analgo-sedation, they also turn blue and there are maybe two electrodes, actually just one electrode, electrode number two, which has I would say poor contact because the bar is almost not moving at all.